Five new obstacles for ObamaCare

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The Obama administration is easing expectations ahead of ObamaCare’s critical second-year enrollment period.

More than a year after HealthCare.Gov’s problems plunged the administration into crisis, the administration faces a very different set of challenges in expanding the healthcare law’s rolls.

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HealthCare.gov is much stronger, insurers are flocking to the exchanges, and federal health officials can claim 7.1 million current enrollees for the system. 

But signing up new customers while retaining old ones still poses significant challenges in year two. 

The Department of Health and Human Services (HHS) lowered expectations for next year by projecting Monday that 9.1 million people would be enrolled in the exchanges, a significant drop from the 13 million estimated by the Congressional Budget Office. 

Here are the top five obstacles facing administration officials in the second enrollment period. 

Less time

In a stroke of luck for the administration, the 2014 enrollment period that began last October was six months long. 

This extended timetable gave federal health officials room to fix HealthCare.gov and still achieve a high number of sign-ups on the exchanges. 

This time, officials have only three months to convince the uninsured to purchase coverage and cope with any unexpected glitches. 

HHS Secretary Sylvia Mathews Burwell says that problems are inevitable, but it's also clear the condensed timeframe is on her mind. 

“Something [bad] will happen,” she said Monday when discussing open enrollment. “What we need to do is be transparent, be fast and get it fixed.”

Reaching the uninsured

In a blow to Republican critics, ObamaCare succeeded at reducing the uninsured rate in its first year. 

This time, the administration and its private-sector allies are devoting fewer resources to publicizing the marketplaces and providing outreach. 

This will make it harder to convince the tens of millions of people who still don't have health insurance to get covered. 

Kaiser Family Foundation President Drew Altman described this group as “people who have been without insurance for a long time or who have never had it.”

“These people are more likely to be men, and minorities, and have limited education or language barriers,” Altman wrote July 21 in The Wall Street Journal

“The remaining uninsured are a somewhat different group presenting new challenges.” 

Re-enrollment confusion

Nov. 15 marks the first time that HealthCare.gov will cope with existing customers who want to change their health coverage. 

This process could reveal new technical problems at the site, as well as issues communicating with health insurance companies on the back end. 

In one scenario, an insurer might not learn their customer has dropped them for a different company. 

In another, an enrollee who stopped paying premiums might be automatically signed up for his or her plan again. 

The administration is encouraging people who already have health coverage on the exchanges to revisit HealthCare.gov in case they can get a better price.

Existing customers will see their coverage automatically renewed if they do not seek changes. 

Glitches

HealthCare.gov was synonymous last year with the technical mess that accompanied its rollout. 

In the last year, the administration has strengthened the site to cope with more users, protect against hackers and make the enrollment process easier. 

This doesn't mean that every flaw is fixed, officials warn. Burwell has sought to manage expectations by noting that some consumers will encounter problems. 

“We will have things that won't go right. We will have outages, we will have downtime,” Burwell said Monday at an event held by the Center for American Progress. 

Political environment

Almost five years out, the Obama administration is implementing the Affordable Care Act in a political environment that remains largely hostile to the law. 

ObamaCare continues to be unpopular with the public, according to opinion surveys, and commitment to “full repeal” is still a litmus test for Republican leaders. 

While GOP opposition is not likely to disrupt open enrollment, it will turn up the pressure at HHS if any glitches should arise. 

Speaker John Boehner (R-Ohio) and incoming Senate Majority Leader Mitch McConnell (R-Ky.) have vowed to take aim at the law when Republicans take control of the Senate in January. 

And in some states, Republican victories make it less likely for governors to pursue the Medicaid expansion.